Summary Background Vascular calcification (VC) is highly prevalent in dialysis (HD) patients, and its mechanism is multifactorial. Most likely that systemic or local inhibitory factor is overwhelmed by promoters of VC in these patients. VC increased arterial stiffness, and left ventricular hypertrophy. Thus, the present study aimed to investigate the association of VC and myocardial remodeling and to analyze their relationship with VC promoters (fibroblast growth factor 23-FGF23, Klotho, intact parathormon-iPTH, vitamin D) in 56 prevalent HD patients (median values: age 54 yrs, HD vintage 82 months). Methods Besides routine laboratory analyzes, serum levels of FGF 23, soluble Klotho, iPTH, 1,25-dihydroxyvitamin D3; pulse wave velocity (PWV); left ventricular (LV) mass by ultrasound; and VCs score by Adragao method were measured. Results VC was found in 60% and LV concentric or eccentric hypertrophy in 50% patients. Dialysis vintage (OR 1.025, 95%CI 1.007–1.044, p=0.006) FGF23 (OR 1.006, 95% CI 0.992–1.012, p=0.029) and serum magnesium (OR 0.000, 95%CI 0.000–0.214, p=0.04) were associated with VC. Changes in myocardial geometry was associated with male sex (beta=-0.273, 95% CI -23.967 1.513, p=0.027), iPTH (beta 0.029, 95%CI -0.059–0.001, p=0.027) and vitamin D treatment (beta 25.49, 95%CI 11.325–39.667, p=0.001). Also, patients with the more widespread VC had the highest LV remodeling categories. PWV was associated patient’s age, cholesterol, diastolic blood pressure, LV mass (positively) and serum calcium (negatively), indicating potential link with atherosclerotic risk. Conclusions Despite to different risk factors for VC and myocardial remodeling, obtained results could indicate that risk factors intertwine in long-term treatment of HD patients and therefore careful and continuous correction of mineral metabolism disorders is undoubtedly of the utmost importance.

Background Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. Methods This cross-sectional study included 156 hemodialysis patients. Comorbidities and laboratory parameters were analyzed. Following clinical examinations, the ankle-brachial index was measured in all patients. PAD was diagnosed based on the clinical findings, ankle-brachial index < 0.9, and PAD symptoms. Results PAD was present in 55 of 156 (35.3%; 95% CI, 27.7–42.8%) patients. The patients with PAD were significantly older (67 ± 10 years vs. 62 ± 11 years, p = 0.014), more likely to have diabetes mellitus ( p = 0.022), and anemia ( p = 0.042), and had significantly lower serum albumin ( p = 0.005), total cholesterol ( p = 0.024), and iron ( p = 0.004) levels, higher glucose ( p = 0.002) and C-reactive protein ( p < 0.001) levels, and lower dialysis adequacies ( p = 0.040) than the patients without PAD. Multivariate analysis showed higher C-reactive protein level (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00–1.06; p = 0.030), vascular access by Hickman catheter (OR, 4.66; 95% CI, 1.03–21.0; p = 0.045), and symptoms of PAD (OR, 5.20; 95% CI, 2.60–10.4; p < 0.001) as independent factors associated with PAD in hemodialysis patients. Conclusion The prevalence of PAD was high among patients with end-stage renal disease on hemodialysis. Symptoms of PAD, higher C-reactive protein levels, and Hickman vascular access were independent predictors of PAD in patients on hemodialysis.

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Introduction. The optimal length of dialysis is still under debate and current regimen of 12 hours a week is medically acceptable. The aim of this observational study was to confirm the relationship between different length of dialysis per week and the parameters of dialysis adequacy and cardiovascular morbidity. Material and Methods. The study included 206 patients (128 man and 78 females) who were on maintenance hemodialysis for more than 6 months. They were classified into three groups according to the length of dialysis per week: group I (12 hours), group II (15 hours) and group III (≥17.5 hours). Results. Index of dyalysis adequacy values did not differ among the groups (group I, II, III = 1.32 vs. 1.51 vs. 1.42; p>0.05); however, the patients from group III had the best bicarbonate level (group I, II and III= 22.7; 21.4; 17.6 mmol/L; p<0.001). In comparison with group I (12 hours), longer dialysis duration was associated with significantly higher hemoglobin values (12.2 vs. 11.4 vs. 10.5 g/dL), less frequent use of erythropoietin stimulating agents (26.9% vs. 65% vs. 86.3%), lower stimulating agents weekly dose (median in group I, II, III=2000 vs. 5000 vs. 4000 I.J.), lower stimulating agents resistance index (4.9 vs. 7.8 vs. 8.8), significantly higher level of serum albumin (42.3 vs. 40.7 vs. 38.2 g/dL), total cholesterol (5.1 vs. 4.7 vs. 4.5 mmol/L) and serum calcium level (2.38 vs. 2.42 vs. 2.28 mmol/L), less frequent use of phosphate binders (53.8% vs. 85% vs. 84.4%) and calcitriol (19.2% vs. 65% vs. 50.6%) and lower intact parathyroid hormone level (336 vs. 363 vs. 446 pg/ml). In addition, longer dialysis duration was associated with lower cardiovascular morbidity score (0.52 vs. 1.05 vs. 1.26). Conclusion. Duration of dialysis per week above the current standard positively correlates with parameters of hemodialysis adequacy. SažetakUvod. Optimalna dužina lečenja hemodijalizom još je neutvrđena, a trenutni režim od 12 sati nedeljno je medicinski prihvatljiv standard. Cilj ove opservacione studije bio je da utvrdi povezanost različite nedeljne dužine lečenja hemodijalizom sa parametrima adekvatnosti hemodijalize i kardiovaskularnim morbiditetom. Materijal i metode. Ovom opservacionom studijom analizirano je 206 bolesnika (128 muškaraca i 78 žena) lečenih duže od 6 meseci koji su bili podeljeni u grupe shodno nedeljnom trajanju dijalize: grupa I (12 h), grupa II (15 h) i grupa III (≥ 17,5 h). Rezultati. Vrednosti indeksa adekvatnosti dijalize nisu se razlikovale između grupa (grupe I, II, III = 1,32 vs 1,51 vs. 1,42 : p > 0,05), ali su bolesnici grupe III imali najbolje korigovanu acidozu (u grupi I, II i III = 22,7; 21,4; 17,6; p < 0,001). U odnosu na standardne dijalize od 12 h, duže nedeljno trajanje dijalize bilo je praćeno značajno višim vrednostima hemoglobina (12,2 vs 11,4 vs 10,5 g/dl), ređom upotrebom agenasa stimulacije eritropoeze (26,9% vs 65% vs 86,3%), manjom nedeljnom dozom agenasa stimulacije eritropoeze (medijana u grupi I, II, III = 2000 vs 5 000 vs 4 000 i.j.), njihovim nižim indeksom ...